Effectiveness of Training Methods in Cytopathology Rotations: 11 Years of Experience

Summary: Introduction: Pathology residency programs offer Cytopathology (Cy) training to their residents (Res), yet evaluating the effectiveness of training methods is scarce. Res complete 3 Cy rotations (R) throughout training, scheduled during their second (R1), third (R2), and fourth (R3) year. Assessments include 16 exam scores, 4 from the Cy section of the annual Resident In-Service Examination (RISE) and 12 from in-house slide exams, including entry and exit R exams in Gynecology (Gyn) and Non-Gynecology (NGyn) specimens. The Res curriculum includes screening Cy cases followed by cytopathologists' feedback, participating in the Rapid On-Site Adequacy, assisting the Fine Needle Aspiration service in our clinic, daily consensus meetings, end-of-R presentations, and journal clubs. In addition, the curriculum includes a robust series of lectures and workshops from faculty. In this study the goal was to evaluate the effectiveness of cytopathology training and impact on Res training over their R1, R2 and R3. Materials and Methods: Training records between 2012-2023 were reviewed including during the COVID-19 pandemic. Inclusion criteria were: 1) Res graduated from our core program, 2) 8 slide-exam scores (at least 2 R), and 3) 3 RISE scores. Anonymity was maintained by assigning codes to the Res. Rs and RISE scores were evaluated for trends across training years. The average scores of the slide exams (entry/exit, Gyn/NGyn) for each R (R1, R2, R3) were also evaluated. Regression analysis was employed to correlate the RISE Cy and R scores. Results: Average Gyn scores ranged from 61% in R1 entry exam to 84% in R3 exit exam, slightly higher than average NGyn scores, ranging from 61-81% from R1 entry to R3 exit exam. Exam scores decreased by 2% and 4% between R1 exit score and R2 entry score for Gyn/NGyn exams. Exams' scores decreased by 4% and 7% between R2 exit and R3 entry exams in Gyn and NGyn. Average R2 and R3 entry exam scores were lower than their most recent preceding exit exams. Average R2 and R3 exit scores were higher than their entry exams (Fig1). R1 entry exams was compared to R3 exit exam in 33 Res who completed all 3 R (Fig 2). Of the 17 Res who scored above the median during R3, 11 had begun above the median in R1; 6 were below. The average senior Res' Cy RISE were higher than juniors'. Average entry and exit exam and RISE scores for both junior and senior Res were maintained throughout the analyzed period including the pandemic (Fig 3). RISE to R exam score correlation was positive, however weak (R2=0.41) (Fig 4). Conclusions: The training was effective not only in above average Res but was also as effective in Res who were below average at the beginning of the Cy training (R1). The program effectively trained Res despite the COVID-19 pandemic. The training was as effective in developing diagnostic skills as well as medical knowledge. A positive but weak correlation existed between the RISE Cy and Cy R scores. This weak correlation is possibly due to tests measuring different aspects of the Res' learning. While R exams require strong morphology skills, the RISE exam requires more theoretical knowledge.